Clinical outcome of planned oocyte cryopreservation at advanced age

PURPOSE

To report outcome of planned oocyte cryopreservation (POC) in the first 8 years of this treatment in our center.

METHODS

A retrospective study in a university-affiliated medical center.

RESULTS

A total of 446 women underwent POC during 2011-2018. Fifty-seven (13%) women presented to use these oocytes during the study period (until June 2021). POC was performed at a mean age of 37.9 ± 2.0 (range 33-41). Age at thawing was 43.3 ± 2.1 (range 38-49). A total of 34 (60%) women transferred their oocytes for thawing at other units. Oocyte survival after thawing was significantly higher at our center than following shipping to ancillary sites (78 vs. 63%, p = 0.047). Forty-nine women completed their treatment, either depleting their cryopreserved oocytes without conceiving (36) or attaining a live birth (13)-27% live birth rate per woman. Only one of eleven women who cryopreserved oocytes aged 40 and older had a live birth using thawed oocytes.

CONCLUSION

Women should be advised to complete planned oocyte cryopreservation before age 40, given low success rates in women who underwent cryopreservation at advanced reproductive age. In this study, oocyte shipping was associated with lower survival rate. These findings may be relevant for women considering POC and utilization of cryopreserved oocytes.

P–448 Clinical outcome of social oocyte cryopreservation at advanced age

Study question

What are the success rates of social oocyte cryopreservation (SOC) at advanced age?

Summary answer

In this study, one in four women who underwent SOC above age 35 had a delivery.

What is known already

While SOC is gaining popularity, reports on delivery rates are limited due to low utilization rates.

Study design, size, duration

Retrospective data collection of all woman who underwent SOC between 2011–2018, and presented for treatment using cryopreserved oocytes until January 2021. Participants/materials, setting, methods: Review of patient records (including both IVF and antenatal/postnatal) and laboratory data in a university affiliated hospital-based IVF unit. Main results and the role of chance: A total of 448 women underwent SOC during 2011–2018. 50 (11.2%) women returned to use these oocytes until the end of January 2021. Women who returned to use their oocytes underwent cryopreservation at mean age of 38.2±2.2. 46 (92%) of participants were above 35 at time of cryopreservation. Number of oocytes cryopreserved was 11.3±9.7. Mean time from cryopreservation to thawing was 5.5±1.8years (range 1–9 years). and age at thawing was 43.4±2.1 (range 40–49). Nearly half of patients initially attempted to conceive before using their cryopreserved oocytes, mostly by ART using fresh oocytes. Mean number of oocytes thawed and oocytes survived per women was 9.7±6.2 and 6.1±4.9 respectively (post thawing survival rate 65.4±35%).

Mean number of embryos transferred, at one or more attempts was 2.6±2.1 per women. Eleven women gave birth or had an ongoing pregnancy > 20 weeks at time of analysis. All deliveries resulted from cryopreservation at age 36 and older (delivery rate 23.9% per women). Limitations, reasons for caution: We report our initial experience of women who underwent SOC at a single center. Most women who returned to use their oocytes had undergone SOC at advanced age, therefore not necessarily reflecting outcome for younger patients attempting to preserve fertility using this technology. Wider implications of the findings: Considering modest success rates of SOC in our cohort, women considering SOC are advised to do so at an earlier age.

Trial registration number

Not applicable

The Hebrew and the Arabic version of the LittlEARS® auditory questionnaire for the assessment of auditory development: results in normal hearing children and children with cochlear implants

OBJECTIVE

With more children receiving cochlear implants at an early age, there is a need for evaluation and assessment of early auditory behavior. We present the translation of the LittlEARS® Auditory Questionnaire into Hebrew and into Arabic. First the validation of the LittlEARS® Auditory Questionnaire in normal hearing children was evaluated. Second, the auditory behavior and the progress in hearing skills of a group of children with cochlear implants were assessed.

METHODS

A "back-translation" method was used to translate and adapt the LittlEARS® Auditory Questionnaire into Hebrew and into Arabic. Normal hearing participants included 70 Hebrew speaking and 97 Arabic speaking parents of children from 1 to 24 months of age with normal hearing. An additional group of 42 parents of children with cochlear implants with a hearing age of up to 24 months completed the LittlEARS® Auditory Questionnaire. 27 of them completed the questionnaire more than once at intervals, so that change and development could be recorded. Scores on the LittlEARS® Auditory Questionnaire were compared to results of SIR and CAP scales and other available auditory data.

RESULTS

The results of the first study show that the curves found for the Hebrew and the Arabic translations of the LittlEARS® Auditory Questionnaire are essentially similar to those previously found for other languages. These curves reflect the age dependency of auditory skills. Furthermore, in the group with cochlear implants the developmental pattern was different than that of the normal hearing group, with an initial steep increase and a later slower improvement. This trend appeared both in curves of groups and in curves of individuals (individuals whose parents completed the questionnaire at several points in time). There was a high correlation between scores on the LittlEARS® Auditory Questionnaire and results of other audiologic tests, showing validity of results with the LittlEARS® Auditory Questionnaire.

CONCLUSION

Both the Hebrew and Arabic versions of the LittlEARS® Auditory Questionnaire were found to be reliable and valid tools for assessment of the development of auditory behavior in children up to the age of 24 months. Furthermore, the LittlEARS® Auditory Questionnaire in both languages is useful in monitoring the progress of children with cochlear implant.

Appropriate indications for venous duplex scanning based on D-dimer assay

Because of the rapid growth in requests for lower extremity duplex scanning, we tested a new rapid D-dimer assay method, the Miniquant test, for its ability to rule out deep vein thrombosis (DVT) in patient subgroups with the following risk factors: malignancy, postoperative state, and cellulitis. One hundred twenty-six consecutive patients with suspected DVT underwent clinical assessment, D-dimer testing with quantitative Miniquant D-dimer assay, and duplex scanning according to standard criteria for the diagnosis of DVT. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated versus duplex scanning for the various risk factor subgroups. Our results showed that the Miniquant D-dimer assay is useful preselection procedure (high NPV) in selected patient subgroups with suspected proximal DVT, including patients with cellulitis and those without malignancy or postoperative state. This preselection procedure has the potential for avoiding a large proportion of unnecessary duplex scanning, thus saving time and reducing costs.

A deletion mutation in GJB6 cooperating with a GJB2 mutation in trans in non-syndromic deafness: A novel founder mutation in Ashkenazi Jews

A deletion of at least 140 kb starting approximately 35kb upstream (telomeric) to the GJB2 (CX26) gene was identified in 7 patients from 4 unrelated Jewish Ashkenazi families with non-syndromic hearing loss. These patients were heterozygous for one of the common mutations 167delT or 35delG in the GJB2 gene in trans to the deletion. The deletion started at 5' side of the GJB6 (CX30) gene including the first exon and it did not affect the integrity of the GJB2 gene. The deletion mutation segregated together with the hearing loss, and was not found in a control group of 100 Ashkenazi individuals. We suggest that the deletion is a recessive mutation causing hearing loss in individuals that are double heterozygous for the deletion and for a mutation in the GJB2 gene. The effect of the deletion mutation could be due to a digenic mode of inheritance of GJB2 and GJB6 genes that encode two different connexins; connexin 26 and connexin 30, or it may abolish control elements that are important in the expression of the GJB2 gene in the cochlea. Regardless which of the options is valid, it is apparent that the deletion mutation provides a new insight into connexin function in the auditory system. The deletion mutation was on the same haplotypic background in all the families, and therefore is a founder mutation that increases the impact of GJB2 in the etiology of prelingual recessive non-syndromic hearing loss in the Ashkenazi population.

Dual energy metabolism-dependent effect of Ureaplasma urealyticum infection on sperm activity

Genital Ureaplasma urealyticum infection is considered a sexually transmitted infection. It has long been debated whether the presence of U. urealyticum in semen may be a possible cause of infertility. Long-term incubation (4 hours or overnight) of sperm cells with U. urealyticum in vitro resulted in a significant inhibition of sperm motility and membrane alteration whereas a short incubation (45 minutes) of sperm cells with ureaplasmas resulted in an acceleration of sperm velocity. The aim of this study was to understand these contradictory reports of U. urealyticum infection on sperm motility. Spermatozoa from fresh ejaculates of normozoospermic semen of men who were referred to the university Male Fertility Laboratory for semen analysis, with no history of genital tract infection, and from normal Assaf breed rams were infected in vitro with U. urealyticum serotype 8, at different pHs and O2 concentrations. Sperm viability and motility and changes in extracellular pH were evaluated. A significant (16%-43%) increase in sperm activity was observed upon infection at alkaline pH (7.8) under aerobic or hypoxic conditions, and a 58% increase was observed under anaerobic conditions and pH 7.2. When the infection was conducted under aerobic conditions and acidic pH (6.3), or under hypoxic conditions at neutral pH (7.2), an 8%-25% inhibition of sperm activity was observed. These results indicate that when sperm activity depends on mitochondrial oxidative phosphorylation, usually at low pHs, U. urealyticum competes with mitochondrial energy production and therefore reduces sperm motility and viability. However, when sperm energy metabolism depends on glycolysis, usually at higher pHs, U. urealyticum stimulates glycolysis and sperm activity.

Contribution of connexin 26 mutations to nonsyndromic deafness in Ashkenazi patients and the variable phenotypic effect of the mutation 167delT

Twenty-seven unrelated Jewish Ashkenazi patients with nonsyndromic prelingual deafness (NSD) were analyzed for mutations in the coding sequence of the connexin 26 (Cx26) gene. Biallelic mutations were identified in 19 of the 27 patients (70.4%); 12 were homozygous for the mutation 167delT, 2 were homozygous for the mutation 35delG, and 5 were compound 167delT/35delG heterozygotes. In addition three patients were heterozygous with no second identified mutation in the Cx26 gene. Biallelic mutations in the Cx26 gene account for 83% of familial cases and 44% of the sporadic cases. Among 268 unselected Ashkenazi individuals, 20 were 167delT/N heterozygotes, giving an estimate of 7.5% carrier frequency. Based on the 167delT carrier frequency in three studies (including the present one), it is expected that 167delT/167delT homozygotes account for 70% of all patients with NSD (1 in 1300). The hearing capacity of 30 patients (probands and their sibs) with biallelic Cx26 mutations and at least one allele with 167delT demonstrated inter- and intrafamilial variability from profound to mild hearing impairment.

Transient evoked otoacoustic emissions in newborns in the first 48 hours after birth

Newborns are often discharged from hospital at the age of about 48 hours. At this age, transient evoked otoacoustic emissions (TEOAEs) are not necessarily recordable in all healthy newborns. In order to determine the factors which would enable the successful recording of TEOAEs before discharge to facilitate screening for hearing, 65 fullterm newborns under 48 hours of age were tested, the youngest being 10 hours old. The ears of those neonates in whom TEOAEs could not be obtained (N = 7 neonates bilaterally, 6 unilaterally) were examined otoscopically, cleaned of vernix and retested for TEOAEs. We were thus able to record in at least one ear in all neonates tested, if the ears were clean, if they were asleep and if the testing room was quiet.

Audiovestibular findings in patients with deafness caused by a mitochondrial susceptibility mutation and precipitated by an inherited nuclear mutation or aminoglycosides

OBJECTIVE

To characterize the audiological and vestibular changes associated with a mitochondrial DNA mutation in an Arab-Israeli family and in other families with mitochondrial predisposition to aminoglycoside-induced hearing loss.

DESIGN

Evaluation of audiological (pure tone thresholds, speech reception thresholds, speech discrimination, tympanometry, acoustic reflex thresholds, tone decay, and auditory brain-stem evoked response recording) and vestibular (complete history, physical examination, and 2-channel electronystagmography) systems. In 5 patients, structural evaluation of the inner ear was done by magnetic resonance imaging.

PATIENTS

Fifteen members of an Arab-Israeli family, and 1 Chinese woman with the same mitochondrial DNA mutation who experienced hearing loss after short-term exposure to streptomycin.

RESULTS

Most of the patients had a profound hearing loss due to cochlear involvement. The hearing loss usually was not accompanied by notable peripheral vestibular dysfunction. In the patient with severe hearing loss after exposure to aminoglycoside, the vestibular function was completely normal.

CONCLUSIONS

In most of the Arab-Israeli patients with congenital deafness, the vestibular system function was normal, in contrast to the frequency of vestibular abnormality among deaf children, which was described in the literature. This may be related to genetic predisposition to aminoglycoside-induced deafness.

Improved staging of B-cell non-Hodgkin's lymphoma patients with 99mTc-labeled LL2 monoclonal antibody fragment

Radioimmunodetection (RAID) with the 99mTc-labeled Fab' fragment of monoclonal antibody (MoAb) LL2 has been reported to have a high lesion detection rate for malignant lymph nodes as well as for visceral and skeletal tumor masses (20). Our purpose in this study was to evaluate the safety and staging efficacy of the 99mTc-labeled Fab' fragment of MoAb LL2 in patients with various grades and stages of B-cell non-Hodgkin's lymphoma (NHL). Thirty adult patients, 13 male and 17 female, ranging in age from 20 to 80 years, with at least one biopsy-proved malignant node (> or = 0.5 cm) and a Karnofsky performance score of > or = 60% were enrolled in this study. Patients underwent selected planar and single photon emission computed tomographic imaging at 6 and 18 h after receiving an i.v. infusion of 0.25-1 mg of LL2 Fab' fragment labeled with 25-30 mCi of 99mTc. RAID findings were compared with physical examination, chest radiography, computed tomography, magnetic resonance imaging, and bone and 67Ga scan findings. The RAID scan was positive in all but three patients. The sensitivity for known lesions was 90% and for suspected lesions, 89%, with an overall positive predictive value of 96%. Twenty-nine of the 30 patients had either low- or intermediate-grade NHL. Fifteen of 16 (94%) low-grade patients were correctly staged by RAID; three of these patients were correctly upstaged. Twelve of the 13 (92%) intermediate-grade patients were correctly staged by RAID; two of these patients were correctly upstaged. The high-grade NHL patient was staged correctly by RAID. Infused doses of 99mTc-labeled LL2 Fab' of 0.5 and 1.0 mg did not affect lesion sensitivity. The RAID sensitivity decreased as the total tumor burden increased > or = 100 g. On the basis of these initial results, the 99mTc-labeled Fab' fragment of MoAb LL2 (LymphoScan) seems to yield useful clinical information, especially for the staging of B-cell NHL patients who do not have bulky disease (i.e., tumor burdens of < or = 100 g).

ABR interpeak latencies in rats are shorter at low click intensities

There are conflicting findings concerning whether auditory nerve-brainstem evoked response (ABR) interpeak latencies (e.g. brainstem transmission time - BTT) are constant in response to different stimulus intensities. In order to study the effects of click intensity on the BTT, and to try to determine the mechanism of such an effect, ABR was recorded from 10 adult white Sabra rats in response to different click intensities. The stimulus intensity was reduced from the highest intensity generated by the equipment until no responses could be obtained. Band-reject (notched) noise was presented simultaneously with the clicks in order to restrict the region of basilar membrane activation. BTT decreased with decreasing click intensity and this was accompanied by a prolongation of the latency of wave I to a greater extent than that of wave IV. At high and intermediate intensities, wave I appeared as two split peaks. These effects were not abolished by the restricting notched noise. Possible mechanisms of these latency changes are considered.

Progressive hearing loss in hard-of-hearing children

A group of 92 children with bilateral sensorineural hearing loss has been followed up over a period of up to 15 years from the time that an initial reliable audiogram was obtained. This group was studied in order to determine the frequency of occurrence of progressive hearing loss and the relationship of the progressive to the presumed etiology of hearing loss. Progression of hearing loss was demonstrated in 21 children out of the 92 children studied. This progression of hearing loss was either bilateral or unilateral, and no evident relationship could be found between the presumed etiology of hearing loss and its progressivity.

Effect of cyclosporine A on the hearing loss in Behçet's disease

Thirty-five patients with Behçet's disease (20 under cyclosporine A [CyA] treatment and 15 under the conventional therapy), 12 patients suffering from endogenous uveitis, and 35 normal subjects were evaluated audiologically before entering the study and were followed up for at least a year. Twenty-eight Behçet patients (80%) showed some degree of hearing loss. The averaged pure tone audiogram of the Behçet group showed statistically significant auditory deficits in comparison with that of the control group. None of either the Behçet group or the uveitis group showed any hearing deterioration during the follow-up period. Five Behçet patients under CyA therapy demonstrated improvement in their hearing. The difference between the two groups of Behçet patients (CyA versus conventional treatment) was found to be statistically significant (p less than .05). Thus, CyA might serve as an important mode of treatment of sensorineural hearing loss on an inflammatory "autoimmune" background.

Decline in the prevalence of childhood deafness in the Jewish population of Jerusalem: ethnic and genetic aspects

A longitudinal study was performed on 147 Jewish children with bilaterally sensorineural hearing loss of moderately severe to profound degree, born in Jerusalem during the eighteen years 1968-85. The prevalence rate of these children declined during the years 1977-85, and at the same time the rate of consanguinity of their parents decreased; this decline was more evident in the genetic group among children with non-Ashkenazi ethnic origin. No such decline was found among the Ashkenazi children and no consanguinity among parents of these children was recorded. Our study supports the assumption that restriction of consanguineous matings may affect the prevalence of genetic deafness in children in a well-defined population. We have tried to remain unbiased and concede certain shortcomings in our present study.

Neonatal auditory brain-stem response threshold and latency: 1 hour to 5 months

Auditory brain-stem evoked responses were recorded in normal neonates and infants ranging in age from less than 1 h to 5.5 months. The average threshold in neonates 0-5 h old was 29 dB greater than that in adults, reaching the adult threshold range within 2 weeks. The latency of wave I in 0-5 h neonates was 1.81 msec and reached the adult range within 2 weeks. The V-I interpeak latency in 0-5 h neonates was 5.3 msec and did not reach adult values within the period of this study.

Auditory nerve and brain stem evoked response thresholds in infants treated with gentamicin as neonates

Thirty-two infants (18 full-term and 14 premature) who had been treated with gentamicin as neonates were examined to ascertain whether this drug induced hearing loss, even of low severity. Objective thresholds to clicks were obtained using auditory nerve and brain stem evoked responses. In addition, behavioral audiometry was performed. Serum concentrations before and after gentamicin treatment were at therapeutic levels. All infants were examined at least 1 1/4 months after cessation of therapy. Normal thresholds were obtained in all ears, with the exception of two with demonstrable middle ear effusion. It appears that gentamicin in therapeutic doses and serum concentrations, in the absence of renal insufficiency, does not cause hearing loss in neonates.

Consanguinity among parents of hearing-impaired children in relation to ethnic groups in the Jewish population of Jerusalem

A longitudinal study was performed on Jewish children with moderately-severe to profound hearing impairment born in Jerusalem during a period of 15 years (1967-1982), and the data on consanguineous matings among their parents were analyzed. These data were estimated in relation to the records obtained in an earlier survey performed on Jewish deaf children during the years 1955-1964. The rate of consanguinity among the parents of hearing-impaired children was much lower in the present survey than in the earlier one in both the Ashkenazi (Central and Eastern European origin) and the non-Ashkenazi (Asian-African origin) group. It is assumed that there is a better understanding of the genetic risk in consanguineous unions, especially when a disability such as hereditary deafness is involved.

Etiology of childhood deafness with reference to the group of unknown cause

A systematic follow-up of children diagnosed as deaf may reveal additional pertinent information which may be instrumental in ascertaining the cause of deafness. 107 deaf children were detected by a prospective study of 62 000 children screened for deafness during 11 years. The cause of deafness could be determined in 63 children while in 44 no etiology was apparent. Investigation of the 44 children revealed a genetic origin of deafness in 12 additional children. Consanguinity was evident in the children whose deafness was of genetic origin. Identification of the cause of deafness in children contributes to prevention of this handicap.

Early detection of hearing loss in infants by auditory nerve and brain stem responses

Auditory-nerve and brain-stem-evoked responses (ABR) have been used alongside standard behavioral hearing tests for the early detection of hearing loss in infants and young children. Two comparisons are presented. The first concerns a group of 65 hearing-impaired children for whom we now have complete pure-tone and speech audiograms. There is a good correlation between the two types of hearing tests in 61 children; the lack of correlation in 4 children is discussed. The second comparison was conducted on neonates. Because ABR testing provides information which is far more accurate than behavioral testing, it is recommended for use in high-risk neonates, especially when mass behavioral screening is not feasible.

Cell kinetics in the epidermis of the toad Bufo bufo bufo (L.) after partial hypophysectomy followed by corticotrophin treatment (an autoradiographic study)

1. Cell kinetic parameters in the epidermis of partially hypophysectomized, ACTH-treated toads whose moulting frequency was increased threefold were studied using labelled thymidine and the autoradiographic technique. 2. The labelling index, length of S-phase and cycle time of stratum germinativum cells changed slowly as a function of the number of ACTH injections, and so did the migration of cells from stratum germinativum to stratum corneum. 3. A cell production in stratum germinativum of normal toads in excess of cell loss, as demonstrated by Levi & Nielsen (1982) should make it possible to maintain a status quo over a limited period of time following ablation of pars distalis and ACTH treatment.

An autoradiographic study of cell kinetics in epidermis of the toad Bufo bufo bufo (L)

Under normal conditions, the toad Bufo bufo bufo molts about once a week. It was considered of interest to study whether the rhythmic pattern of cell loss through shedding of a stratum corneum is correlated with a rhythmic production of cells in stratum germinativum. An autoradiographic investigation of cell kinetics in toad skin using [3H]-thymidine and [14C]-thymidine as precursors revealed that cell production in stratum germinativum is a continuous process, and the cell production rate is much higher than is required for replacement of the cells lost with each molt. The parameters measured, i.e., % labeled cells, length of cell cycle, and S-phase, as well as migration of labeled cells from stratum germinativum toward stratum corneum support the assumption of an inhomogeneous cell population in stratum germinativum. A model proposed by Potten form the cellular organization of mouse epithelium provides a useful basis for the interpretation of the results obtained in the present study.

Follow-up of 40,000 infants screened for hearing defect

During a 7-year period beginning in 1967, approximately 40,000 infants born in Jerusalem were screened for hearing impairment. The hearing of all infants who visited the well-baby clinics at the age of 7-9 months (85% of the child population) was tested and a set of selective criteria was applied to them to detect the children at risk of hearing impairment. Those children suspected of having a hearing impairment were followed up at the Speech and Hearing Center of the Hadassah University Hospital. 69 children were identified as having substantial hearing impairment (moderate to profound); the distribution of risk factors among them is presented. Rehabilitation was carried out from infancy to preschool age, at which time the children were enrolled in suitable educational frameworks. The role of the parents was crucial. At the age of 6 years, many of the hearing-impaired children were integrated into the elementary school system; others attended the School for the Deaf or special institutions. The distribution of the hearing-impaired children in the various school systems is discussed.

Bullous myringitis: its relation to sensorineural hearing loss

Bullous myringitis is considered to be a self-limiting disease without complications. Clinical evidence has shown it to be frequently accompanied by sensorineural hearing loss, more often than it was thought to be. The case of a 20-year-old girl is presented in whom bullous myringitis was accompanied by transient sensorineural hearing loss. The site of the lesion was determined to be in the cochlea. We determined, with a high degree of certainty, that the causative agent was mycoplasma.